Basic Information
Provider Information | |||||||||
NPI: | 1578814216 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RODRIGUEZ | ||||||||
FirstName: | GABRIELA | ||||||||
MiddleName: | TERESITA | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CASTILLO | ||||||||
OtherFirstName: | GABRIELA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1910 CUSTOMER CARE WAY | ||||||||
Address2: |   | ||||||||
City: | ATWATER | ||||||||
State: | CA | ||||||||
PostalCode: | 953015167 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2093846493 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1717 LAS VEGAS ST | ||||||||
Address2: |   | ||||||||
City: | MODESTO | ||||||||
State: | CA | ||||||||
PostalCode: | 953585500 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2095764200 | ||||||||
FaxNumber: | 2095565064 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/20/2012 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | ASW67933 | CA | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
No ID Information.